Towards the end of last year, Graham King, Chief Information Officer at Newcastle upon Tyne Hospitals NHS Foundation Trust delivered a live webcast on the trust’s Electronic Patient Record (EPR) journey.
Part of our HTN Now Focus event on EPR systems, Graham’s presentation focused on the implementation and project ‘Paperlite’, to reduce Newcastle Hospitals’ reliance on paper recording.
Providing background on the North East trust, Graham first explained the scope of the organisation – which has around 1.72 million patient contacts per annum, is home to 1,650 beds, and employs 17,500 members of staff. He added that the trust generates around 7,500 clinical documents per day across its 40 sites.
Graham explained that, despite being the focus of his talk, Newcastle’s EPR journey did not start with Paperlite – it actually began way back in 2009, when the trust went live with Cerner, including Inpatient Orders and Medications, a Patient Administration System (PAS) and picture archiving. After a hiatus, digital correspondence followed in 2016 through document management, before the implementation of nursing tracking boards and electronic observations in 2017.
Due to operating in a “hybrid state of some paper, some electronic” systems, “the flow was not particularly great”, explained Graham. The trust then became a Global Digital Exemplar (GDE) site and went live with its Paperlite programme in 2019, moving clinical, nursing and Allied Health Professional documentation into a digital format.
To achieve its goals around reducing paper, Newcastle Hospitals had four ‘guiding principles’: to do it right and do it once; to implement it across the whole organisation for everyone, everywhere; to use one system; and to give people what they needed rather than exactly what was asked for.
The organisation’s reasons included – first and foremost – patient safety and patient experience, as well as to improve research and auditing, boost organisational efficiency, and to make financial savings.
Graham also explained which aspects of the EPR were Cerner’s core components, which were Newcastle’s own, and which were third-party integrated systems. The CIO then went on to detail how his team gained both clinical and executive engagement through a series of meetings and open forum events, as well as via the mapping of current processes through 77 workshops across two weeks, to show where efficiencies could be gained.
The team then went further – by conducting a week-long event to show staff what they could expect, with presentations on each functional area taking place every day, as well as break-out sessions and glimpses or ‘first looks’ at the hardware options, which then enabled staff feedback.
“It gave context to the questions that we would be asking them later on in the design sessions for each area – they needed to make their decisions about where they wanted things, how they would navigate…it was really about making sure we took them through the design process and they were fully engaged on that,” he said.
Moving on to testing, Graham highlighted the importance of the three cycles of user acceptance testing in mock environments and full dress rehearsals of what go-live would be like, so that the team could get each department to sign-off on the functionality.
“That sounds really quick and easy [but] it took a long time,” Graham said, “the key to getting a quality product is that, at a point in time, you must stop making changes to the system and say ‘that’s actually what we’re going to go live with’…that was quite a challenge.”
On training – which encompassed working with around 10-12,000 staff over 10 weeks – additional rooms and trainers were required, with online booking systems to make it simpler, as well as a library of quick video guides and pocket handbooks for each staff group. With these measures in place, the team managed to train 95 per cent of all staff before go-live.
Discussing hardware, Graham explained that “one of the key bits was changing the screen size” to 21 inches for user experience, while additional laptops, laptop carts and label printers were required, as well as PC upgrades.
“It’s not just about the system, it’s about whether all the components are there to be able to use that in a consistent way, [if] access is there, you’ve got a standardised mechanism for saying what a ward needs in terms of one cart per bay or one cart for every four cubicles, [while] critical care has a screen for each bed. You work through that until you have an agreed format,” he commented.
After taking the audience through the organisation’s control function, Graham moved on to the go-lives and their challenges, as well as early life support, which included retaining trainers for the first two weeks, having 50 floor walkers over six weeks, and using video conferencing and instant messaging technology so that floor walkers could communicate. They even had the team kitted out in their own purple branded clothes, so that they were visible to staff when they needed support, he added.
On the results, Graham noted: “Everything now is real-time reporting – you can see now in the Command Centre, [bed] capacity, occupancy, how many are closed…we’ve got real-time ED [Emergency Department] tracking and ED escalation, a Command Control screen for deteriorating patients, and we’ve continued to augment that with sepsis alerts…it’s allowed us to bring all the data to a single point and use that to manage the flow within the hospital.”
“We’ve also seen a massive reduction in the cost of the paper, we’ve closed one of the medical records libraries…post and printing costs have dropped, we’ve seen some time gain and some time losses…you can now see the record anywhere,” he added.
Graham also touched on the impact of the COVID-19 pandemic on work to make the system more efficient, explaining that the team are now going back to revisit areas. “Going live gets you to a digital record, it doesn’t mean you’ve got a good digital record – you’ve got to consistently and constantly maintain that…and constantly recycle back,” he said, noting that go-live is only the “start of the journey”.
To conclude, Graham then spoke briefly about regional cooperation through the Great North Care Record and Health Information Exchange, outlining how population health planning and a patient engagement platform have benefitted patient experience and safety, made processes easier for staff and enabled “truly integrated care” across the North East.
He then handed over to the audience for a detailed Q&A session. To watch the full session and Graham’s answers to the audience questions, view the video below: